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Young women bear the brunt of the HIV epidemic in sub-Saharan Africa. Women acquire HIV acquisition about 5-7 years earlier than men and young women in the 15-19 year age group have 3-6 fold higher rates of HIV infection compared to males in the same age group. The current HIV prevention options namely abstinence, behaviour change, male and female condoms, HIV testing and medical male circumcision are not feasible options for these young women and underscore the importance of female initiated prevention options. For the past two decades there has been substantial effort in finding a microbicide. In July 2010, the CAPRISA 004 trial demonstrated for the first time that 1% tenofovir gel was efficacious in preventing HIV and HSV-2 infection, 39% and 51% respectively. Sub-group analysis of the CAPRISA 004 data has identified several key lessons for enhancing the efficacy of tenofovir gel and informing the conduct of future PrEP and microbicide trials. These include adherence, drug levels and genital inflammation.

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(CIT): Young women bear the brunt of the HIV epidemic in sub-Saharan Africa. Women acquire HIV acquisition about 5-7 years earlier than men and young women in the 15-19 year age group have 3-6 fold higher rates of HIV infection compared to males in the same age group. The current HIV prevention options namely abstinence, behaviour change, male and female condoms, HIV testing and medical male circumcision are not feasible options for these young women and underscore the importance of female initiated prevention options. For the past two decades there has been substantial effort in finding a microbicide. In July 2010, the CAPRISA 004 trial demonstrated for the first time that 1% tenofovir gel was efficacious in preventing HIV and HSV-2 infection, 39% and 51% respectively. Sub-group analysis of the CAPRISA 004 data has identified several key lessons for enhancing the efficacy of tenofovir gel and informing the conduct of future PrEP and microbicide trials. These include adherence, drug levels and genital inflammation.